Benefits Eligibility Coordinator

Hchmd; Baltimore (MD); Presencial; USD 49.000 - 57.000; Jornada completa

Descripción de la vacante

Hchmd in Baltimore, MD is seeking a Benefits Eligibility Coordinator to work across a multi-specialty Federally Qualified Health Center, ensuring clients are assessed for health insurance eligibility and that Medicaid MCO pre-certifications are secured for reimbursement.

The role includes supervising a team of Benefits Eligibility Specialists, coordinating with HCAM, MCOs, and state agencies, and driving efficient workflows within the revenue cycle while maintaining HIPAA compliance.

Formación

• Associate degree or equivalent experience in health access or related field.
• Certified Navigator certification required within six months of hire.
• Experience with HIPAA, ADA, and health insurance regulations.
• Three years of health insurance eligibility/verification experience.

Responsabilidades

• Directly train, supervise and appraise a team of Benefits Eligibility Specialists.
• Perform duties of a Certified Insurance Navigator as needed.
• Coordinate with external entities (Medicaid MCOs, HCAM, HC benefits).
• Monitor KPIs and implement efficient workflows in revenue cycle.

Conocimientos

Team leadership

Supervision

Health insurance eligibility

HIPAA & ADA knowledge

Motivational Interviewing

De-escalation techniques

Training and development

Public health insurance knowledge

Educación

Associate’s degree

Certified Navigator certification

Herramientas

Practice management systems

Descripción del empleo

Benefits Eligibility Coordinator# Benefits Eligibility Coordinator421 Fallsway - Baltimore, MD 21202## OverviewSalary Range$48,981.00 - $57,144.00 Salary/yearPosition TypeFull Time## Benefits Eligibility CoordinatorDepartment: Practice OperationsReports To: Director of Client AccessJob Family: Practice OperationsFLSA Status: ExemptEEO Classification: Administrative support workersSupervisor: YesLeadership Level: Emerging LeaderJob Function Status: Essential On-SiteOverviewThe Benefits Eligibility Coordinator works across an integrated multi-specialty federally qualified health center to ensure that clients are assessed for health insurance eligibility, and behavioral health providers have Medicaid MCO pre-certifications that enable them to be reimbursed for their services. The Coordinator maintains collaborative working relations with state and city entities to assist clients with access to insurance benefits.Key Role Responsibilities* Directly train, supervise and appraise a team of Benefits Eligibility Specialists. Set, model and reinforce clear expectations, monitor outcomes, create a culture of open communication, and help team members solve complex problems through group and individual supervision.* Perform and fulfill the duties and responsibilities of the Benefits Eligibility Specialists, including all duties of a Certified Insurance Navigator.* Ensure a coordinated approach to assisting clients with access to insurance benefits in partnership with external entities, including the Maryland Health Benefits Exchange, Medicaid Managed Care Organizations, Health Care Access of Maryland (HCAM), the Department of Social Services and Medicare.* Monitor, track and report upon Benefits Eligibility goals and key performance indicators. Implement and maintain efficient workflows, guidelines, and procedures. Ensure the team understands how benefits fit in the revenue cycle.* Ensure compliance with applicable agency, local, state, federal and regulatory bodies and guidelines in day-to-day activities. Uphold terms of the HCAM practice entity agreement through regular audits.* Coordinate with Practice Managers to align benefit eligibility processes, training and support across all sites.* Oversee the process that ensures timely behavioral health prior authorizations are approved for clients per MCO rules. Coordinate with behavioral health providers to improve these processes and workflows, ensuring eligible clients receive authorization before services are delivered.* Serve as an agency subject matter expert related to public health insurance. Provide consultation to managers and staff on insurance benefits, limitations and regulations.* Model customer service excellence marked by culturally competent, client-centered, ethical, respectful, inclusive and professional access for clients, partners and the broader community.## Qualifications**Knowledge, Experience and Skills**Formal Education and Training* Associate’s degree required of relative experience (equivalent combination of training and experience may be considered)* Certification as a Certified Navigator (required within six months of hire)* Training in Motivational Interviewing preferred* Training in De-escalation techniques preferred* Knowledge of medical, administrative, ethical and the legal requirements of HIPAA and ADAExperience* Three (3) years of experience working with health insurance eligibility/verification or similar role required* One (1) year of supervision required* Familiarity working with underserved populations preferred* Experience working with computers and practice management systemsSkills* Able to work independently, self-manage and meet deadlines* Possess good written and oral communication skills* Able to build a team, motivate staff and delegate tasks using a strengths-based approach* Work collaboratively, resolve conflicts and provide thoughtful, constructive and actionable input* Maintain and safeguard confidentiality in a variety of settings* Remain calm, dependable and respectful, no matter the circumstance* Act with high ethical standards* Proactively seek out training to learn and improve* Able to cope with interruptions; flexible